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FOR OFFICE USE: <br /> APPLICATIONS SANIZATION PERMIT 3 <br /> ..............................4....._..........€......... Permit No. <br /> .............. <br /> _� Xornp!�to In Triplicato) <br /> ..........I..................................a........ <br /> *6 <br /> A <br /> this Permit Expires I Your From Date Issued <br /> Doti Issued <br /> ............. ........... ........ <br /> ...... ..... <br /> Application is hereby made to the Son Joaquin Lokail,Health District for a permit to construct and install the work herein <br /> described.-This pipplication.is,made in compliancer-with Cd6nty Ordinance No'. 549 and existing Rules and Regulations: <br /> JOB ..........&et.74:�..CENSIJS TRACT ...A04.0....... <br /> Owner's Name ...... o�. R.77_.... ................... •--....Phone .ZVT :;*M.... <br /> Address6IV46 op 0 0 <br /> .......—1-01ew.................city ------------- ...... <br /> Contractor's Name,_ ------ ... . . .......... <br /> --------------------------------- <br /> Installation will serve: <br /> esidence rtment Hou!eiq Commercial OTtollir..Court. 0 <br /> )MI , & <br /> otel 0 Other......... .............::tn............... <br /> Number of living units.-- Number of bedrooms ---Garb/06"'Grinder Z! Size .14MUIC-4.0-f................... <br /> N <br /> Water Supply: Public System and name' .................................... ........ ....Priv <br /> -------------- ........... to <br /> Character of soil to a-de- pth of 3 fedt: -SandL] Silto Clay & 'Peat 0-, Sandy lo'am_Adobe ClayLoomo.4 i. <br /> "Hardpon.0 Fill Mitterial pe 0 <br /> (Plot pi <br /> on, showing size of lot, location of system in relation to wells, buildings, etc."must el <br /> be placed on reverse sld *,'_�O, <br /> i <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> • <br /> PACKAGE TREATMENT Siz <br /> Z ... <br /> SEPTIC TANK I I <br /> ...... ..................I........ Liquid Depth ......................... <br /> .... TypV&.,44..... Material i L 2*W4&?W_ N0. '�Compartments,i,.A..... <br /> Capacity 40S, <br /> Distance to nearest: Well ...foundprfion :.All?�.......... Prop. Line <br /> LEACHING LINE No. ------ eacO [neeV -7%5,.;5aTotaI Length ..-Vle4 ....... <br /> Length of I <br /> Type Filter Material ------------------Depth Filter Material ................ ........ <br /> Distance,,to'nearest: Well Foundation _44�........ t�. Property Line m'0?0....... <br /> &U-0-A th <br /> Z644T- iter ----_-------_ Num�er .. .......__........ Filled Yes ,[] No-C� <br /> +ns <br /> ---------_---- .......... ........R <br /> T6 .... ...............R Size ............... ................ <br /> Nistce 0 oreit. Well ..............0............... .........Foundation .................... Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation- Permit# .............................. ........ Dote .................................. <br /> SepticTank ISpecify'Requirements) .............. ...... ........................... ................................. ......... ............................. <br /> Disposal'Field (Spi&'cify Requirements) ............................................ .................................. <br /> ---------- -------------------------- <br /> ..........................X_­......... --------------- .......................... ...... .................................I........ ............................-,, --­-----­­------­ <br /> ----------------- <br /> ----------------------------------- ........ ---------------------------------.......................... ..........................................................I....... <br /> :1 jDraw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work.M�ilf be in'accordance.with Son Joaquin <br /> County Ordinances, State Laws,-and Rules and Regulations of the Son Joaquin-Local Health:District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the py.farmance',of the work for which this permit is Issued, I shell. not employ any person In such manner <br /> as to be lNecklo Wo an's Compensation aws of California.­ <br /> w & _ 4 <br /> 01 <br /> V - <br /> .Signe "df-1 q rj <br /> --------------------- <br /> Wes <br /> --------------- <br /> ---------------- ---- Owner <br /> By ........ --------------- <br /> ---------------------------- .............................. Title ........... ----------- ............. ........ ............ <br /> (If other tha_n owner) <br /> F9FDEP 4RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- = ------------------- DATE., .&WW----- ...... <br /> .................... <br /> BUILDING PERMIT ISSUED _...... ............4�, -4".x ;�. <br /> .. <br /> ADDITIONAL COMMEI`ffS 04 <br /> .... ...... ------------- <br /> ----------- ----------------------------------------------­-- ------ -------------------:,-.:.......................... <br /> ----------------------- ----------------------------- -------------------------------------------------------------------------------- <br /> ----------------------­' <br /> ............... --------------------------- ------­1 .......I .........­1---------­-----­----­--- -------­----- <br /> final Inspection by ---------• 01 . . .. .. ............I—_------- ---------------- ------ .......Date . <br /> EH 13 21: 1-68 i?ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />